So why should it be thought so strange to want to learn from every accident in health care.” Sir Liam Donaldson, 2001 This is the eleventh series of the Victorian Audit of Surgical Mor
About this report
The VASM is an integral component of the Australian and New Zealand Audit of Surgical Mortality (ANZASM), a nationwide initiative focused on enhancing surgical care quality By conducting independent peer-review assessments, the VASM identifies clinical management issues that impact patient safety This process leads to the development of targeted strategies aimed at addressing these concerns and improving overall surgical outcomes.
In 2012, the RACS mandated an audit as part of the CPD program, with compliance assessed based on the number of cases that successfully completed the audit process Comprehensive details regarding the VASMs audit process flow chart can be found in the Governance Structure and Data.
Management sections of the Supplementary Report
The VASM monitors trends in surgical mortality and clinical management issues in order to identify areas for improvement in the care delivered by health services in Victoria
This report outlines key findings and recommendations for the period from July 1, 2017, to June 30, 2018 It includes tables and figures that illustrate data collected between July 1, 2012, and June 30, 2018, highlighting changes over time.
To further assess emerging trends, and to benchmark outcomes of surgical care, case comparisons have been made between VASM and ANZASM
The VASM has undergone three external audits by Aspex Consulting to evaluate its functionality, with the initial review taking place in 2012 and the most recent in 2018 This report includes the current recommendations from Aspex Consulting as part of the key findings.
This year's audit highlights the necessity for hospitals and surgeons to enhance clinical management and address preventable outcomes outlined in Section 15, 'Outcomes of Peer-Review.' Additionally, the findings indicate that VASM data can be effectively leveraged to align with the National Safety and Quality Health Service standards.
(NSQHS) Standards The messages from the key findings are reiterated in Section 7 ‘Key recommendations’ Other areas of improvement for the VASM are outlined in Section 5 ‘Future Goals for the
The VASM team expresses gratitude for the invaluable support and assistance from numerous individuals and institutions that contributed to the project's development, as detailed in the Supplementary section.
Executive Summary
In 2012, the RACS mandated an audit as part of the CPD program, with compliance assessed based on the number of cases that successfully completed the audit process.
The denominator for the current year was 891, with any unavailable data excluded from the analysis It's important to note that data may be missing at different stages of the review process, such as during the initial surgical case submission or the subsequent first and second-line assessment stages This variability accounts for differences in the denominator for a single measure.
To evaluate emerging trends and benchmark surgical care outcomes, we compared cases between VASM and ANZASM The clinical data for our review was primarily supplied by the treating consultants rather than junior medical staff.
Hospital admission and operative patient profile
The audit revealed that most surgical deaths occurred in elderly patients with pre-existing health issues, with 82.2% (732 out of 891) admitted as emergencies due to acute life-threatening conditions requiring surgery The causes of death were frequently associated with these patients' underlying health statuses, often reflecting their pre-existing illnesses It was determined that these deaths were largely not preventable and were direct outcomes of the disease processes rather than the surgical treatments administered.
Surgery was not performed due to a conscious decision made by the patient, family, or clinician, particularly in emergency cases where the clinical problem was deemed untreatable.
The majority of surgical procedures performed were related to trauma or acute abdominal conditions, highlighting the significant number of emergency admissions Additionally, it is common for patients to undergo multiple surgeries during their hospital stay.
There were 93% (829/891) of patients having at least one operation during their final hospital admission
Of the patients who had surgery, 14.8% (122/827) had an unplanned return to the operating theatre due to complications
A consultant was present in theatre in 84.2% (956/1,135) of operations compared to the national rate at 75.0% (2,301/3,066)
Summary of key findings based on 891 peer-reviewed cases from the audit period 1 July 2017 to 30
• The majority of VASM clinical indicators were comparable to the national audit data.
• More patients were admitted as emergencies with acute life-threatening disease.
• A patient can undergo multiple operative procedures during their hospital stay.
• A surgical consultant was involved in most surgeries, particularly when the patient was readmitted to theatre.
• The top three comorbidities that contributed to death were: cardiovascular, advanced age and respiratory.
• The top three causes of death were: multi-organ failure, sepsis and respiratory failure.
• Delays in surgical diagnosis increased slightly from the previous reporting period.
• Most reported infections were acquired postoperatively.
• Clinical management issues can occur perioperatively during a patient’s hospital stay.
• Futile surgery, as reflected in the decision to operate, is one of the top clinical management issues.
• Falls occur mostly at home and at care facilities.
Victorian Audit of Surgical Mortality - 2018 VASM Repor t
During the trending period (2012-2018), a consultant surgeon performed the majority of operative procedures in theatre for 80.6% (6,992/8,672) of operations for the VASM compared with 74.2%
(16,875/22,756) nationally, p